Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections

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Abstract

OBJECTIVE:

To examine burnout prevalence among California neonatal intensive care units (NICUs) and to test the relation between burnout and healthcare-associated infection (HAI) rates in very low birth weight (VLBW) neonates.

STUDY DESIGN:

Retrospective observational study of provider perceptions of burnout from 2073 nurse practitioners, physicians, registered nurses and respiratory therapists, using a validated four-item questionnaire based on the Maslach Burnout Inventory. The relation between burnout and HAI rates among VLBW (< 1500 g) neonates from each NICU was evaluated using multi-level logistic regression analysis with patient-level factors as fixed effects.

RESULTS:

We found variable prevalence of burnout across the NICUs surveyed (mean 25.2 ± 10.1%). Healthcare-associated infection rates were 8.3 ± 5.1% during the study period. Highest burnout prevalence was found among nurses, nurse practitioners and respiratory therapists (non-physicians, 28 ± 11% vs 17 ± 19% physicians), day shift workers (30 ± 3% vs 25 ± 4% night shift) and workers with 5 or more years of service (29 ± 2% vs 16 ± 6% in fewer than 3 years group). Overall burnout rates showed no correlation with risk-adjusted rates of HAIs (r = -0.133). Item-level analysis showed positive association between HAIs and perceptions of working too hard (odds ratio 1.15, 95% confidence interval 1.04-1.28). Sensitivity analysis of high-volume NICUs suggested a moderate correlation between burnout prevalence and HAIs (r = 0.34).

CONCLUSION:

Burnout is most prevalent among non-physicians, daytime workers and experienced workers. Perceptions of working too hard associate with increased HAIs in this cohort of VLBW infants, but overall burnout prevalence is not predictive.

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